The NCD Alliance, an international network of over 2000 organizations working on
non-communicable diseases (NCDs) including cancer, cardiovascular disease, chronic
respiratory diseases, and diabetes, believes the outcome document from the Rio+20
conference must contain a strong focus on health, specifically the threat to sustainable
development and poverty eradication posed by the global NCD epidemic.

Rio +20 will be a critical opportunity to build on the efforts already underway to
accelerate progress towards sustainable development and reduce poverty and inequality,
which will ultimately contribute toward the prevention and control of NCDs worldwide.

Overall outcomes of the conference should be sustained political commitment and
willingness to adequately address and invest in NCD prevention and control on the
local, national, regional, and international levels. The conference will also provide a
platform for Member States and other stakeholders to follow up on the commitments
made during the UN High-level Meeting (HLM) on the Prevention and Control of Noncommunicable
Diseases, held on 19-20 September 2011 at UN Headquarters.

NCDs since the Johannesburg Declaration

The 2002 Earth Summit in Johannesburg, South Africa, putforth a comprehensive
agenda for action on sustainable development. Paragraph 19 of the Johannesburg
Declaration on Sustainable Development highlights a key area for further attention in
the Rio+20 Outcome Document. It states:

?We reaffirm our pledge to place particular focus on, and give priority attention
to, the fight against the worldwide conditions that pose severe threats to the
sustainable development of our people, which include...endemic, communicable
and chronic diseases, in particular HIV/AIDS, malaria and tuberculosis...?1

In the 10 years since the adoption of the Johannesburg Declaration, NCDs (referred to
as chronic diseases in the declaration above)have emerged as one of the foremost
development challenges of the 21st century. There is growing evidence that NCDs are
impeding progress to achieving the UN Millennium Development Goals
(MDGs).Effective prevention and control of NCDs requires that these diseases not be
dealt with in isolationbut be fully integrated into all aspects of theglobal development
agenda.

NCDs and the eradication of poverty

The linkages between NCDs and sustainable development, particularly as a means
toward the eradication of poverty, are clear and require concrete actions on the part of
all stakeholders.

Member States unanimously adopted a Political Declaration during the HLM
recognizing NCDs as a global development priority and the?the vicious cycle whereby
NCDs and their risk factors worsen poverty, while poverty contributes to rising rates of
NCDs, posing a threat to public health and economic and social development.?

According to the World Health Organization, 100 million people are pushed into
poverty annually because they have to pay directly for health services, which results in
up to 5% of the population being forced into poverty in many countries.

In addition to the economic burden they place upon individuals, families, and
communities, NCDs are already having devastating consequences on the global
economy. A recent study by the World Economic Forum and Harvard University
estimates that NCDs will cost the world economy $47 trillion over the next 20 years,
representing 75 percent of annual global GDP and surpassing the cost of the current
global financial crisis.

NCDs in the green economy

WHO?s Health in the Green Economy series, published in spring of 2011, highlights the
relationship between sectors of the green economy and health and recommends
solutions that both mitigate climate change and improve health conditions, particularly
in low-income settings.5 The NCD Alliance urges Member States and other stakeholders
to strongly consider these solutions in the discussions and outcomes of the Conference.

The NCD Alliance suggests the following priorities for consideration during the
Rio+20 Conference:

Health systems integration: The NCD Alliance urges governments to integrate NCDs
into existing health policies and health systems strengthening initiatives, refocusing
health systems on prevention, health education, and chronic disease care. Strengthened
health systems will also benefit other diseases and conditions, including HIV/AIDS and
other infectious diseases. The Rio Declaration should reaffirm the commitment made by
Heads of State in the Political Declaration issued at the HLM to ?promote, establish or
support and strengthen, by 2013, as appropriate multi-sectoral national policies and
plans for the prevention and control of non-communicable diseases? (para 45).

Development goals: The MDGs currently contain no goals or targets for NCDs. Yet,
NCDs cause 60 % of all deaths globally (36 million) each year and four out five of these
deaths occur in low- and middle-income countries. It is therefore critical that Member
States include NCDs in discussions at the Conference and at the 2013 MDG Review
Summit, and commit to including targets on NCDs in the follow up development
framework when the current MDG goals expire in 2015.

Donor assistance: Less than 3% of official development assistance (ODA) on health is
spent on NCDs.6The NCD Alliance requests all governments with major overseas aid
programmes to low and middle income countries to end the policy ban on funding
NCDs that most bilateral donors operate now. Bilateral donors countries must live by
the commitments made in the Paris Declaration on Aid Effectiveness. The Rio
Declaration should support the commitment in HLM Political Declaration to ?promote
all possible means to identify and mobilize adequate, predictable and sustained
financial resources and the necessary human and technical resources, and to consider
support for voluntary, cost-effective, innovative approaches for a long-term financing of
non-communicable disease prevention and control? (para 49).

Whole of Government engagement: NCD plans must involve the whole of
government, not just the health sector. Action to prevent and control NCDs requires the
active engagement of ministries of finance, foreign affairs, education, Agriculture, and
transportation, trade and others.

Adopt policies to prevent NCDs: Only governments have the power to regulate
environments so that healthy food, smoke free places and physical activity are the norm
and not the exception. The NCD Alliance expects governments to regulate unhealthy
food content ? salt, trans-fats and sugar - and harmful use of alcohol through policies on
price, availability and marketing. Governments must accelerate implementation of the
Framework Convention on Tobacco Control (FCTC) and tax tobacco to the level
recommended by the WHO to both reduce tobacco use and generate revenues that can
be used for sustainable development.

Universal access to NCD medicines, technologies and care as a human right:
Today, over 100 million people with NCDs are denied access to the basic medicines
(including for pain relief), technologies, education and care they need to stay alive and
stay healthy.7 Individuals and families in many contexts are being tipped into poverty by
catastrophic expenditure on NCD care. NCDs are not new diseases and many can be
treated effectively with off patent medicines. NCD prevention, and investment in early
NCD diagnosis and treatment, is both morally right and sound economic strategy.

Follow Up Action on Non-communicable Diseases: Heads of State committed to a
?comprehensive review and assessment in 2014 of the progress achieved in the prevention
and control of non-communicable disease? (para 65) in the HLM Political Declaration.

The Rio Declaration should recommend that this review culminate in a High-Level Meeting
of the United Nations to ensure that prevention and control of NCDs are given adequate
follow-up as a priority factor in achieving sustainable global development.